PICU中央导管相关血流感染患儿的临床特点分析:单中心回顾性研究  

Analysis of clinical characteristics of pediatric patients with central line-associated bloodstream infection in pediatric intensive care unit: a single-center retrospective study

作　　者：王晓晖[1] 钱素云[1] Wang Xiaohui;Qian Suyun(National Center for Children′s Health,Department of Pediatric Critical Care Medicine,Beijing Children′s Hospital,Capital Medical University,Beijing 100045,China)

机构地区：[1]国家儿童医学中心首都医科大学附属北京儿童医院,100045

出　　处：《中国小儿急救医学》2019年第7期492-496,共5页Chinese Pediatric Emergency Medicine

基　　金：北京市外国专家局引进国外技术管理人才项目资助(BJ2018042);北京市医院管理局临床医学发展专项经费资助(ZYLX201813).

摘　　要：目的分析PICU医院获得性中央导管相关血流感染( central line associated bloodstream infection,CLABSI)患儿的临床和感染率的变化特点,发现管理中的不足,借鉴国外CLABSI的防控措施,提高CLABSI的防控水平.方法选取北京儿童医院重症医学科2014年7月至2017年9月确诊的CLABSI病例,收集患儿临床信息,计算CLABSI的感染率、住院病死率等指标,明确现阶段我科感染患儿的临床特点和感染状况,找到现行实践标准中需改进之处.结果共有13例CLABSI病例,均为股静脉置管,其中血液肿瘤患儿最多(4例),占比30.8%.感染率由2014年0.4例/千置管日上升至2017年的2.5例/千置管日,导管使用率从24.5%升至26.6%,感染以革兰阴性菌为主(7/13),住院病死率23.1%.结论我科近年CLABSI病例增多,应在现行实践标准基础上补充"最大无菌屏障"措施,增设置管日预警标识,每日评估导管留置的必要性以降低感染率.Objective To analyze the clinical characteristics and change in the infection rate of pediatric patients with hospital-acquired central line-associated bloodstream infection(CLABSI) in PICU, and identify the deficiencies in management, and learn from the experience of developed countries in preventing and controlling CLABSI.Methods The cases of CLABSI diagnosed in the PICU of Beijing Children′s Hospital from July 2014 to September 2017 were selected, the clinical information of the pediatric patients was collected, and the infection rate, the in-hospital mortality, and other indicators of CLABSI were calculated to clarify the clinical characteristics and infection status to improve the current practice standard.Results A total of 13 cases of CLABSI had femoral vein catheters.Among them, hematological tumors were the most common(4/13).The infection rate increased from 0.4 cases/1 000 catheter days in 2014 to 2.5 cases/1 000 catheter days in 2017, while the catheter utilization rate increased from 24.5% to 26.6%, children infected with Gram-negative bacteria were the most common(7/13)and the in-hospital mortality was 23.1%.Conclusion In recent years, the number of CLABSI cases has increased.The "maximum sterile barrier" measures should be supplemented to the current practice standards, the warning signs for catheter days should be added, and the necessity of indwelling catheter should be evaluated daily to reduce the rate of infection.

关 键 词：儿童 重症监护病房 医院获得性感染 中央导管 血流感染 

分 类 号：R473.72[医药卫生—护理学]